NPIMap

Organization Active NPI

Addiction Specialist of Southern California, Inc.

  • Adult Mental Health Clinic/Center
  • Newport Beach, CA
National Provider Identifier
1700626629
Registry record updated May 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
ADDICTION SPECIALIST OF SOUTHERN CALIFORNIA, INC.
Practice address
4000 Macarthur Blvd
Suite 600 East Tower
Newport Beach, CA 92660-2517
Phone
(949) 390-4730
Fax
(949) 627-8107
NPI assigned
May 29, 2024
Last updated
May 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lawrence Vernon Tucker, M.D.NPI 1669453262
Title
Owner
Phone
(949) 390-4730

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

4000 Macarthur Blvd
Suite 600 East Tower
Newport Beach, CA 92660-2517

Mailing address

66 English Saddle
Irvine, CA 92602-1839
Phone (949) 390-4730

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1700626629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "66 ENGLISH SADDLE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926021839",
            "telephone_number": "949-390-4730",
            "fax_number": "949-627-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MACARTHUR BLVD",
            "address_2": "SUITE 600 EAST TOWER",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602517",
            "telephone_number": "949-390-4730",
            "fax_number": "949-627-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADDICTION SPECIALIST OF SOUTHERN CALIFORNIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "VERNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-390-4730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.